KDA Today

KDA Today

For Immediate Release

Date: Apr 24th, 2017
Contact: Dr. Beverly A. Largent
Phone: 800-292-1855
Email: info@kyda.org

The Daunting Task of Changing Someone Elses Bad Habits

A recent article in Dr. Bicuspid by the editor, Tony Edwards, has given me heart burn. Mr. Edwards writes about research on the effectiveness of early dental care for kids. The title, of course, got my attention; I rarely read all of the online articles posted by this magazine. This was an editorial comment on an article appearing in the Journal of the American Medical Association, which sought statically-significant evidence concerning early visits to the dentist or other health care provider and the effectiveness of the dental home in preventing disease and lowering the cost of dental treatment. The title of the article is “Outcomes Associated With Early Dental Care Among Medicaid-enrolled children in Alabama.” The full article is easily accessed online, published in JAMA Pediatrics. The lead author is Justin Blackburn, PhD.

The “dental home” concept is near and dear to the hearts of pediatric dentists. It was adopted in 1992, by the American Academy of Pediatric Dentistry and later accepted by the American Dental Association, and the American Academy of Pediatrics. For anyone who encounters the ravages of decay in very young children, it is considered to be the only way to possibly intercept the progress of disease in this population. Certainly, not every pediatric dentist sees children younger than three, and not everyone is a proponent of the dental home for the very young child. Much discussion has ensued over the years about the effectiveness of the early dental home in preventing decay. If we believe Dr. Blackburn and his cohorts, many of us have been working in vain, and some of us have actually caused states to spend more on treatment of the Medicaid population. “We observed no evidence of a benefit of early preventive dental care, regardless of the provider,” the authors concluded. “In fact, preventive dental care from dentists appears to increase caries-related treatment.”

These conclusions were drawn from a retrospective study of a group of nearly 20,000 children enrolled in Alabama Medicaid from 2008-2012. These children were enrolled from birth, and the study sought to estimate “the effect of early preventive dental care on caries-related visits and expenditures. Dentist-related care was associated with an increase of 0.14 caries related visits per child, and a $40.77 increase in expenditures per child-year when compared with primary care providers who had no statistically significant effect.” The authors state that more study is needed.

The online article in JAMA Pediatrics is accompanied by an editorial by Drs. Peter Milgrom and Jona Cunha-Cruz, who point to deficiencies in the study, one of which is that the guidance on fluoride toothpaste, and the use of sugary drinks and food is not recorded in the Medicaid data. My favorite is “Finally, we cannot rule out the possibility that there is a true effect in which preventive visits lead to higher caries-related treatment as a result of ineffective anticipatory guidance and fluoride varnish applications.”

Really? Do they mean that the dentist-patient/parent relationship is truly valuable, and that the application of fluoride varnish to the masses is ineffective? If so, then this must be my favorite research of all time. I see on the average of five babies a day (babies are children under three years of age). I cannot imagine why anyone would bring their infant to the dentist, if they were not interested in preventive dentistry. Note that I used the word interested, not proficient in tooth brushing or choosing the proper diet. Rarely, do I see these children’s parents make an about-face, and start to clean the child’s teeth daily or remove the night time bottle, immediately. Usually, by three visits, they begin to adopt the information and make some changes. One change is that they do not want to hear about the disclosed plaque on their child’s teeth, so I see much cleaner teeth, if only for the visit in my office. The most significant changes come if the child has experienced tooth decay. I have learned that changing someone else’s habits are just as difficult as changing my own. I have had the problematic task of telling a mom with moon-shaped decay on her teeth that she can negatively impact the health of her child, and that she cannot share utensils, and should be very careful about kissing her baby on the mouth. These parents are fragile, and I give only the information I think they can use. Too much is overwhelming and insulting.

Despite the noise of the child and the nervousness of the parent, these visits are the favorite part of my day. I readily admit that motivating a mom to brush the teeth of a baby who has a dirty face is challenging and often met with resistance. Motivation is not easy. Changing habits is not easy. My mamma never dreamed of my challenges, and could not tell me they would not be easy. Yes, fluoride varnish is an invaluable asset, and I am happy to have it in my tool box. I am still waiting for the inoculation against decay, and as long as fluoride varnish is considered as such, we will be reading articles like the one from Dr. Blackburn.

 

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